The fear of developing Diabetes due to the use of cholesterol lowering drug Statins made headlines in the past few years.

We use Statins to lower cholesterol known to cause heart attack and stroke. Studies have shown that statins indeed can lower ones risk to suffer a heart attack or stroke. So when the issue of this drug increasing the blood sugar…which then is the lesser evil?

Or are we treating on one disease and in return give rise to another disease?

The risk of developing diabetes mellitus with statin therapy is limited to patients already at a high risk for developing diabetes. These individuals include those with impaired fasting glucose, metabolic syndrome, severe obesity, or increased hemoglobin A1c (HbA1c) levels.

In these high-risk patients however, the benefits of statin therapy outweighed the risk of diabetes

This is therefore a very welcome development in this area of Medicine.

Let me share with you this interesting article from The Coopenhagen Heart Study soon to be published presented at EuroPRevent2012 in Dublin on the effect of jogging on one’s health and one’s life .

The study has one simple but strong conclusion:

Men who regularly jog can add at least 6.2 years to their life.

Women who regularly jog can add 5.6 years to their life.

How Much Jogging is necessary to reap the benefits?

Not that long but a mere 1 hour up to 2 hours and 30 min per week that can be broken down in 2 to 3 sessions, done at slow to average pace that can leave you a little breathless. Don’t OVERDO it though because the figures from the study indicate that people who do a lot of jogging actually had the tendency to die early similar to those who don’t engage in jogging at all.

There you go guys. My daily “me time” of running around the block in my own home backyard every afternoon at least 2 x is therefore not only ideal but a perfect pace for long life.

Remember in another study done few years ago, maintaining an aerobic fitness through middle age has been shown to delay biologic aging by 12 years.

Almost a resounding YES! Until recently the British Medical Journal 2012 published an article that looked at frying and the risk of heart disease. The data will otherwise give us a smile for most who love frying as a way to cook and enjoy food!

Abstract

Objective To assess the association between consumption of fried foods and risk of coronary heart disease.Design Prospective cohort study.Setting Spanish cohort of the European Prospective Investigation into Cancer and Nutrition.Participants 40,757 adults aged 29-69 and free of coronary heart disease at baseline (1992-6), followed up until 2004.Main outcome measures Coronary heart disease events and vital status identified by record linkage with hospital discharge registers, population based registers of myocardial infarction, and mortality registers.Results During a median follow-up of 11 years, 606 coronary heart disease events and 1,135 deaths from all causes occurred. Compared with being in the first (lowest) quarter of fried food consumption, the multivariate hazard ratio of coronary heart disease in the second quarter was 1.15 (95% confidence interval 0.91 to 1.45), in the third quarter was 1.07 (0.83 to 1.38), and in the fourth quarter was 1.08 (0.82 to 1.43; P for trend 0.74). The results did not vary between those who used olive oil for frying and those who used sunflower oil. Likewise, no association was observed between fried food consumption and all cause mortality: multivariate hazard ratio for the highest versus the lowest quarter of fried food consumption was 0.93 (95% confidence interval 0.77 to 1.14; P for trend 0.98).Conclusion In Spain, a Mediterranean country where olive or sunflower oil is used for frying, the consumption of fried foods was not associated with coronary heart disease or with all cause mortality.

It is always our notion that frying is really bad. Foods that are fried lose water and instead take up fat and increase the caloric density of the food that is fried. Worst is when the oil is reused as one loses the healthier unsaturated fat and instead increases the amount of the unhealthiest fat which is the trans fat! What is known is that the risk of obesity and overweight strongly correlated with eating fried foods but this is the only study so far that has evaluated prospectively the relationship between fried foods and cardiovascular disease.

In this study population, the detailed analysis of the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition significantly found no association between consumption of fried food and risk of coronary heart disease or all cause mortality.

Some explanations can be made:

1. The oil used in the study was mainly olive and sunflower rather than solid fat. Olive oils is less prone to oxidation than other edible oils or fat.

2. We are not talking here of fried food in Fast food Burger joints where oils used in deep frying are reused several times and therefore unhealthy!

3. The analysis should not be made to say that fried chips or snacks therefore are safe because the study population here has low consumption of fried snacks that are usually loaded with salt.

It’s been another hectic day. On impulse, you grab an extra-large candy bar during your afternoon break. You plan to take just a few bites. But before you know it, you’ve polished off the whole thing — and, at least temporarily, you may feel better.

Rest assured you’re not alone. Stress, the hormones it unleashes, and the effects of high-fat, sugary “comfort foods” push people toward overeating.

Effects on appetite

In the short term, stress can shut down appetite. A structure in the brain called the hypothalamus releases corticotropin-releasing hormone, which suppresses appetite. The brain also sends messages to the adrenal glands atop the kidneys to pump out the hormone epinephrine (also known as adrenaline). Epinephrine helps trigger the body’s fight-or-flight response, a revved-up physiological state that temporarily puts eating on hold.

But if stress persists — or is perceived as persisting — it’s a different story. The adrenal glands release another hormone called cortisol, and cortisol increases appetite and may also ramp up motivation in general, including the motivation to eat. Once a stressful episode is over, cortisol levels should fall, but if the stress doesn’t go away — or if a person’s stress response gets stuck in the “on” position — cortisol may stay elevated.

Fat and sugar cravings

Stress also seems to affect food preferences. Numerous studies — granted, many of them in animals — have shown that physical or emotional distress increases the intake of food high in fat, sugar, or both. High cortisol levels, in combination with high insulin levels, may be responsible. Other research suggests that ghrelin, a “hunger hormone,” may have a role.

Once ingested, fat- and sugar-filled foods seem to have a feedback effect that inhibits activity in the parts of the brain that produce and process stress and related emotions. So part of our stress-induced craving for those foods may be that they counteract stress.

Of course, overeating isn’t the only stress-related behavior that can add pounds. Stressed people lose sleep, exercise less, and drink more alcohol, all of which can contribute to becoming overweight.

Different responses

Some research suggests a gender difference in stress-coping behavior, with women being more likely to turn to food and men to alcohol or smoking. A Finnish study that included over 5,000 men and women showed that obesity was associated with stress-related eating in women but not in men. Other research has shown that high stress levels lead to weight gain in both women and men, but the effect is typically greater in men.

Harvard researchers have reported that stress from work and other sorts of problems correlates with weight gain, but only in those who were overweight at the beginning of the study period. One explanation: overweight people have elevated insulin levels, and stress-related weight gain is more likely to occur in the presence of high insulin.

How much cortisol people produce in response to stress may also factor into the stress–weight gain equation. Several years ago, British researchers designed an ingenious study that showed that people who responded to stress with high cortisol levels in an experimental setting were more likely to snack in response to daily hassles in their regular lives than low-cortisol responders.

Steps you can take

Stress reduction is a growth industry these days.

There are dozens of things to try. Here are three suggestions:

1. Meditate. Countless studies show that meditation reduces stress, although much of the research has focused on high blood pressure and heart disease. Meditation may also help you be more mindful of food choices. With practice, a person may be able to pay better attention to the impulse to grab a fat- and sugar-loaded comfort food and inhibit the impulse. 2. Exercise more. Intense exercise increases cortisol levels temporarily, but low-intensity exercise seems to reduce them. University of California researchers reported results in 2010 that exercise — and this was vigorous exercise — may blunt some of the negative effects of stress. Some activities, such as yoga and tai chi, have elements of both exercise and meditation. 3. Visit with friends. Social support seems to have a buffering effect on the stress people experience. For example, researchers have found that the mental health of people working in stressful situations, like hospital emergency departments, is better if they receive it. But even those of us who live and work in situations where the stakes aren’t as high will, as Lennon and McCartney suggested, be better off if we get a little help from our friends.

The WordPress.com stats helper monkeys prepared a 2011 annual report for this blog.

Here’s an excerpt:

London Olympic Stadium holds 80,000 people. This blog was viewed about 300,000 times in 2011. If it were competing at London Olympic Stadium, it would take about 4 sold-out events for that many people to see it.

2011 has been very busy for me as i was inducted as the President of the American Association of Clinical Endocrinologists Philippines (AACE Philippines). My term will end by August 2012. This is the only year where I did not have a post every month.

One of the legacies I want to give and share during my presidency is the giving back our precious time to help and treat those in far flung barangays who cant afford the fee of a specialist. Thus was born the Goiter Obesity Osteoporosis and Diabetes (GOOD) doctors outreach and medical mission held end of November 2012. The group was able to treat and helped 2800 residents of Argao, Cebu. a total of 40 specialists from all over the country helped in the effort.

Overall…the feeling of having helped and served your fellowmen is what makes the true essence of what a doctor is all about.

Recent article published in AMERICAN JOURNAL OF PUBLIC HEALTH brings us back to how fast our world is becoming obese and how slow we have been in addressing this issue. The temptation to eat and the lack of discipline to follow what is right and adequate make each one of us vulnerable to this dreaded condition we call Obesity.

Objectives. We examined the effect of an intervention to provide caloric information about sugar-sweetened beverages (SSBs) on the number of SSB purchases.

Methods. We used a case-crossover design with 4 corner stores located in low-income, predominately Black neighborhoods in Baltimore, Maryland. The intervention randomly posted 1 of 3 signs with the following caloric information: (1) absolute caloric count, (2) percentage of total recommended daily intake, and (3) physical activity equivalent. We collected data for 1600 beverage sales by Black adolescents, aged 12–18 years, including 400 during a baseline period and 400 for each of the 3 caloric condition interventions.

Letting out kids understand the nutrition information of the food they eat versus telling them how long they have to workout or exercise to burn the calories can make a difference.

The impact was noticeable more if kids understand how long they have to run to burn the amount of calories they ingested from the sugary drinks. The easier it is for everyone to understand the equivalent amount of physical activity of what we take in makes sense. You get a clearer picture of what you need to do to burn those calories.

A great article and a great wake up call for everyone.

AACE Philippines as part of our advocacy is providing modules to Grade school students on the Power of Prevention Through Fitness and Nutrition or POPFTN. For this year, we already have started the program and involved the Grade 5 students of St Bennedicts and for January, we will go to PAREF Springadale both in Cebu. AACE Philippines as an organization composed of Endocrine Specialists dealing with Diabetes, Obesity and endocrine diseases hope to make a difference in the early lives of these kids.

The concept of taking mutivitamins as a way to improve health has never been proven. It has not been shown to cause harm BUT has not been shown to help reduce disease… so when a study on multivitamin around 2009 came out saying that taking these supplements has not been shown to have any effect on health or disease prevention…I literally stopped taking one.

Now comes a new study that gtives us more doubt on this practice. A study published in Archives of Internal Medicine, Oct issue showed that these supplements are not helpful healthwise, they can actually be HARMFUL

Methods We assessed the use of vitamin and mineral supplements in relation to total mortality in 38 772 older women in the Iowa Women’s Health Study; mean age was 61.6 years at baseline in 1986. Supplement use was self-reported in 1986, 1997, and 2004. Through December 31, 2008, a total of 15 594 deaths (40.2%) were identified through the State Health Registry of Iowa and the National Death Index.

Conclusions In older women, several commonly used dietary vitamin and mineral supplements may be associated with increased total mortality risk; this association is strongest with supplemental iron. In contrast to the findings of many studies, calcium is associated with decreased risk.

This study confimrs what I have been suspecting in a long time. As a supplement, these drugs are not being screened for what they contain. The drugs dont need to prove they work… for them to be sold in the market nor are these drugs required to show their long term safety. Now I hope the public knows better!!!!

In this paper, the patients who were studied took supplements in the form of calcium, multivitamins, vitamin C, and vitamin E. The data showed that the use of multivitamins especially those containing vitamin B6, folic acid, iron, magnesium, zinc, and copper supplements were associated with greater all-cause mortality through 19 years of follow-up. This is BIG news!!!!

What then is our recommendation?

Better invest in healthy lifestyle. As always, it has been our advocate to promote what is proven right and safe. Eat right and Move!!!

Avoid taking a palm full of supplements thinking this can make one live longer and healthier because on the contrary…the fewer supplements or ZERO supplements – the better!!!! We cannot and will NEVER recommend the use of vitamin and mineral supplements as a preventive measure!!!!, As they dont add anything beneficial from what we can get by eating the healthy fruits and vegetables!

It is known that high sugar and high cholesterol in the blood spell trouble. Any diabetics almost always has high blood pressure or high cholesterol problem. Therefore, we aggressively treat their sugars, blood pressure and cholesterol hoping to lower their risk to suffer from a stroke and heart attack.

Most often, doctors tend to forget to remind patients to be more physically active. Some patients also feel so comfortable that they are already on medications that they dont need to watch out what they eat or do.

Now comes a new study presented at the Annual Meeting of the American College of Sports Medicine that looked at the value of regular physical activity among patients already on aggressive lowering of sugar and cholesterol and see if regular exercise contributes further to preventing heart disease.

This is so far the first study to document that if one exercise reglarly at least 30 minutes like walking, further reduction in ones risk to heart disease progression can be seen. When pulse wave activity was measured after 2-5 years, those that exercise less or not at all, had a 14% increase in pulse wave activity suggesting more arterial stiffness. The study confirms that progression of atherosclerosis or blockage of blood vessels can be sloweddown or halted by adding physical activity to the usual medications we give to lower sugar and cholesterol.

This study further emphasizes to all of us that whatever we do and have in life…

Lack of sleep causes stress. Stress increases stress hormones that can increase glucose. Understandably,lack of sleep equals risk for diabetes. I used to believe from previous studies that a duration of sleep less than 7 hours increases ones risk to develop diabetes.

Now comes a new study published in Diabetes Care March 2011, that tell us Quality is important than Quantity…

OBJECTIVE To examine whether sleep duration and quality are associated with fasting glucose, fasting insulin, or estimated insulin resistance in a community-based sample of early middle-aged adults.

RESEARCH DESIGN AND METHODS This was an ancillary study to the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Habitual sleep duration and fragmentation were estimated from 6 days of wrist actigraphy collected in 2003–2005. Insomnia was defined as self-reported difficulty falling asleep or waking up in the night three or more times per week plus average sleep efficiency of <80% based on actigraphy. Fasting blood samples to measure glucose and insulin were collected after the sleep measures during the CARDIA clinical examination in 2005–2006. Insulin resistance was estimated using the homeostatic model assessment (HOMA) method. Analyses were cross-sectional and stratified by the presence of diabetes.

RESULTS There was no association between sleep measures and fasting glucose, insulin, or HOMA in the 115 subjects without diabetes. Among the 40 subjects with diabetes, after adjustment for covariates, 10% higher sleep fragmentation was associated with a 9% higher fasting glucose level, a 30% higher fasting insulin level, and a 43% higher HOMA level. Insomnia was associated with a 23% higher fasting glucose level, a 48% higher fasting insulin level, and an 82% higher HOMA level.

CONCLUSIONS The observed association between poor sleep quality and higher glucose, insulin, and estimated insulin resistance among subjects with diabetes warrants further examination of the effect of sleep disturbances on glucose control in type 2 diabetes.

In the study, sleep duration was assessed as the amount of sleep obtained per night while sleep fragmentation was based on the periods of restlessness and movements that the pateints had during the night.

What is interesting in the study was that there was no association between sleep duration and glucose metabolism in groups with or without diabetes. This is in contrast to earlier studies which showed otherwise.

However sleep fragmentation was signicantly associated with increasing blood sugar so that for every 10% higher sleep fragmentation, there was an associated 9% higher fasting glucose and higher insulin level suggesting insulin resistance. What is important is that sleep fragmentation WAS not associated with higher glucose if one is NOT a diabetic. Meaning, sleep disturbance is a risk factor for poor blood sugar control among diabetics!

In conclusion, the authors assessed that POOR sleep and NOT Short Duration is associated with poor glucose control!!! That intervention to warrant investigations of causes for poor sleep can help make diabetics have better control.

So do you snore? and probably stop breathing often?

Ask your partner… and better have your sleeping pattern assessed as this may lead to better control of your blood sugar if corrected!

It has always been my practice to make sure women take their daily calcium supplements to prevent osteoporosis. It is my contention that by building bone the right way and preventing a fracture is very important health issue. It is recommended by diffirent medical societies that calcium supplements be given between 1000- 1200 mg per day.

Now comes a new study showing proofs that calcium supplements may not be that safe after all. A study published in BMJ in JUly 2010 with a reanalysis done in 2011 showed that calcium supplementation should be reviewed due to inherent harm.

Abstract

OBJECTIVE:

DESIGN:

Patient level and trial level meta-analyses.

DATA SOURCES:

Medline, Embase, and Cochrane Central Register of Controlled Trials (1966-March 2010), reference lists of meta-analyses of calcium supplements, and two clinical trial registries. Initial searches were carried out in November 2007, with electronic database searches repeated in March 2010.

STUDY SELECTION:

Eligible studies were randomised, placebo controlled trials of calcium supplements (>or=500 mg/day), with 100 or more participants of mean age more than 40 years and study duration more than one year. The lead authors of eligible trials supplied data. Cardiovascular outcomes were obtained from self reports, hospital admissions, and death certificates.

RESULTS:

15 trials were eligible for inclusion, five with patient level data (8151 participants, median follow-up 3.6 years, interquartile range 2.7-4.3 years) and 11 with trial level data (11 921 participants, mean duration 4.0 years). In the five studies contributing patient level data, 143 people allocated to calcium had a myocardial infarction compared with 111 allocated to placebo (hazard ratio 1.31, 95% confidence interval 1.02 to 1.67, P=0.035). Non-significant increases occurred in the incidence of stroke (1.20, 0.96 to 1.50, P=0.11), the composite end point of myocardial infarction, stroke, or sudden death (1.18, 1.00 to 1.39, P=0.057), and death (1.09, 0.96 to 1.23, P=0.18). The meta-analysis of trial level data showed similar results: 296 people had a myocardial infarction (166 allocated to calcium, 130 to placebo), with an increased incidence of myocardial infarction in those allocated to calcium (pooled relative risk 1.27, 95% confidence interval 1.01 to 1.59, P=0.038).

CONCLUSIONS:

Calcium supplements (without coadministered vitamin D) are associated with an increased risk of myocardial infarction. As calcium supplements are widely used these modest increases in risk of cardiovascular disease might translate into a large burden of disease in the population. A reassessment of the role of calcium supplements in the management of osteoporosis is warranted.

The reanalysis of this study done recently and published in the same journal showed that the risk of MI is actualy MODEST at best around 20% for MI and 30% for stroke BUT… considering the huge number of women doctors have been recommending to take calcium supplements… justify a further close look at this practice as this will have enormous impact on health care risk.

For the past year…I have not been recommending calcium supplements to my patients especially my diabetic hypertensive patients. I make sure that my dietitian supplements their diet with enough calcium sources from food and milk. If need be, those patients who cant take enough from food are the ones given the supplements but this number is becoming less each day.

If you are taking calcium supplements on your own , my recommendation is to stop. If you are taking the supplements as part of your osteoporosis program then talk to your doctor first before stopping.

Ive long been cautious of letting my kids use cell phones even for a short period of time. Their brains are still developing and need the best nurturing they can get and if we can limit inflicting harm to avoid long term defects would be ideal.

A novel study recently published in JAMA tells us that cell phone use was shown to affect brain activity:

Context The dramatic increase in use of cellular telephones has generated concern about possible negative effects of radiofrequency signals delivered to the brain. However, whether acute cell phone exposure affects the human brain is unclear.

Design, Setting, and Participants Randomized crossover study conducted between January 1 and December 31, 2009, at a single US laboratory among 47 healthy participants recruited from the community. Cell phones were placed on the left and right ears and positron emission tomography with (18F)fluorodeoxyglucose injection was used to measure brain glucose metabolism twice, once with the right cell phone activated (sound muted) for 50 minutes (“on” condition) and once with both cell phones deactivated (“off” condition). Statistical parametric mapping was used to compare metabolism between on and off conditions using paired t tests, and Pearson linear correlations were used to verify the association of metabolism and estimated amplitude of radiofrequency-modulated electromagnetic waves emitted by the cell phone. Clusters with at least 1000 voxels (volume >8 cm3) and P < .05 (corrected for multiple comparisons) were considered significant.

Results Whole-brain metabolism did not differ between on and off conditions. In contrast, metabolism in the region closest to the antenna (orbitofrontal cortex and temporal pole) was significantly higher for on than off conditions (35.7 vs 33.3 μmol/100 g per minute; mean difference, 2.4 [95% confidence interval, 0.67-4.2]; P = .004). The increases were significantly correlated with the estimated electromagnetic field amplitudes both for absolute metabolism (R = 0.95, P < .001) and normalized metabolism (R = 0.89; P < .001).

Conclusions In healthy participants and compared with no exposure, 50-minute cell phone exposure was associated with increased brain glucose metabolism in the region closest to the antenna. This finding is of unknown clinical significance.

Analysis of the data showed that the human brain is indeed sensitive to the effects of radiofrequency from acute cell phone use. And that the area closest to the antennae revealed the highest brain activity. Whether this disruption in brain activity has long term consequences is still unknown.

Take Home message?

Use the phone for texting…and use it sparingly for calling.

Restricting use of cell phones in kids will continue to be my recommendation until better studies will show that indeed its use is safe for kids until age 18. Too late? well better be safe than sorry….

But hopefully soon before my son reaches tha age where cell phones are a must..we have better studies showing its safety…Cross my fingers!!!

It has always been my notion that tylenol is the safest of all pain relievers. Most patinets of mine are advised to take acetaminophen instead of NSAIDS especially if they have arthritis and have concomitant heart disease or kidney problem. We all know about the Viox controversy when it was pulled out due to cardiovascular safety.

Now comes a recent report from the Harvard Health Beat regarding a Swiss study that showed taking acetaminophen better known for the brand Tylenol, can actually cause an elevation of Blood pressure.

The researchers asked 33 men and women with one or more of these problems to take either 1,000 milligrams (mg) of acetaminophen or an identical placebo three times a day for two weeks. Then, after a two-week break, each volunteer took the other treatment. The amount of acetaminophen used in the study is a standard daily dose for pain.

When the participants took acetaminophen, average systolic blood pressure (the top number of a blood pressure reading) increased from 122.4 to 125.3, while the average diastolic pressure (the bottom number) increased from 73.2 to 75.4. Blood pressure stayed steady when participants took the placebo. These increases aren’t large. But they indicate that acetaminophen, like NSAIDs, somehow affects the cardiovascular system.

Acetaminophen indeed is a safe alternative to the pain killers known as NSAIDs becuase it is safe to the stomach and avoid gastric irritation.

It is also a better alternative especially to patients taking anticoagulants or drugs to prevent blood clots because it does not interfere with their actions nor further increase bleeding tendencies.

However… people should be extra careful with this new information and therefore should not take acetaminophen lightly. Meaning, one should also be cautious in taking acetaminophen with a slight onset of headache especially among patients with concomitant cardiovascular disease.

No matter how safe a drug is perceived to be… along the way comes an alternative that will always be safer… or the other way around. It is best that we be kept informed because we may be taking drugs that may instead cause harm than good. It is therefore always worth having a periodic visits to your family doctor.

ATA underscores importance of KI distribution prior to nuclear emergencies The tragic events in Japan over the last several days underscore the importance of distribution of potassium iodide (KI) in regions surrounding nuclear power plants. Radioactive iodine can be released in nuclear accidents. Infants and children are particularly at risk for thyroid cancer following exposures to high levels of radioactive iodine. If taken soon after exposure to the radioactive iodine released during a nuclear emergency, potassium iodide can help to provide protection against thyroid cancer. Distribution of potassium iodide in the area around a nuclear reactor prior to an accident can ensure that it is available in a timely fashion, even in the setting of major disruptions to transportation and other infrastructure, as have occurred in Japan.

Since 1984, the American Thyroid Association has advocated that:

Potassium iodide should be part of an emergency plan that includes evacuation, sheltering, and avoiding contaminated food, milk, and water.

Potassium iodide should be made available to populations living within 200 miles of a nuclear power plant.

Potassium iodide should be “predistributed” to households within 50 miles of a plant.

I am planning to publish this article for my son to read in FB ( which he is allowed to do in my room only during weekends) and for the other parents to reconsider the practice of allowing kids to play video and internet games at their leisure. It is easy to use these gadgets as surrogate nannies because they make our kids stay put and have their own world. Part of the compromise for busy parents is to buy their kids the best gadgets because kids wont complain their absence as long as they have the gadgets to enjoy.

Now comes a study published in Pediatrics regarding the long term dangers of allowing our kids to enjoy these gadgets on a daily basis:

Objectives : We aimed to measure the prevalence and length of the problemof pathological video gaming or Internet use, to identify riskand protective factors, to determine whether pathological gamingis a primary or secondary problem, and to identify outcomesfor individuals who become or stop being pathological gamers.

Methods : A 2-year, longitudinal, panel study was performed with a generalelementary and secondary school population in Singapore, including3034 children in grades 3 (N = 743), 4 (N = 711), 7 (N = 916),and 8 (N = 664). Several hypothesized risk and protective factorsfor developing or overcoming pathological gaming were measured,including weekly amount of game play, impulsivity, social competence,depression, social phobia, anxiety, and school performance.

Results: The prevalence of pathological gaming was similar to that inother countries (9%). Greater amounts of gaming, lower socialcompetence, and greater impulsivity seemed to act as risk factorsfor becoming pathological gamers, whereas depression, anxiety,social phobias, and lower school performance seemed to act asoutcomes of pathological gaming.

Conclusion: This study adds important information to the discussion aboutwhether video game “addiction” is similar to other addictivebehaviors, demonstrating that it can last for years and is notsolely a symptom of comorbid disorders.

I have always been against supplements. As a physician where safety to patients is of utmost importance, giving drugs that are marketed as natural, herbal and safe without any research background and no published studies in REPUTABLE journals is not acceptable. This also holds true to Chinese medications. Anybody can just print out a magazine touting the benefits and health effects of certain hebral prepartations and present these to clients as proofs that these natural supplements work! Not only are they unsafe, they may also have interactions with the drugs we give that really can help our patients.

Here’s one reason why I refuse to recommend supplements to my patients…this is a recent experience published in Medpage Today, January issue on an over the counter ” natural” supplements to help patients lose weight….

The marketer of two dietary weight-loss supplements sold as “100% all natural” issued a voluntary recall of the products after FDA testing confirmed they contained the banned weight-loss drug sibutramine.

The FDA has received a number of adverse event reports related to Fruta Planta and Reduce Weight Fruta Planta, including multiple cardiac events and one death.

Sibutramine, withdrawn from the U.S. market in October 2010 due to an increased risk of stroke and myocardial infarction, may also cause patients to experience elevated blood pressure or pulse rate; may increase risk to patients with a history of coronary artery disease, congestive heart failure, arrhythmias, or stroke; and may have negative and life-threatening interactions with some drugs.

The agency recommended consumers stop using the product and throw any remaining samples away in a sealed container or return the product to the marketer, PRock Marketing of Kissimmee, Fla. Patients who experience any negative side effects from the product should consult a healthcare professional immediately.

The risk is enormous because these products may contain true drugs that are already banned but are not included in the product label. As a result these supplements will really work because they contain active drug ingredients. The risk involves doctors not knowing what to expect in terms of side effects. The patients also take them lightly without regard to the effects on their body becuase they are “Herbal”, ” Natural” and apparently without side effects!

So please take note. The above story is just one of the many horror stories we have encountered as medical practitioners.

Its always difficult to wake kids up during school days…more difficult to let them eat. I usually alternate oatmeal, cereals and rice on my kids breakfast meal. Oats with fruits and milk, low sugar Cherrios cereals and in between days they get rice and eggs with ham. It is always good to start the kids young and learn the importance of a healthy breakfast.

The mistake that parents always have with regard to kids food choices is that we always allow our kids to dictate what they like to eat. Or rely our kids meals on their yayas. It is easier for us to fry chicken with french fries because for sure the kids will eat them BUT are they healthy? Likewise yayas find it easier to feed fried chicken than veggies. As the saying goes..at least they eat rather than no breakfast! This is the reason why in the long run, parents will find it difficult to introduce healthy food choices for the kids.

Now comes a new study published in Pediatrics that these Cherrios low sugar cereals are really acceptable options for a healthy breakfast. Likewise surprisingly kids love them!

Objectives To test (1) whether children will consume low-sugar ready-to-eat(RTE) cereals and (2) the effects of serving high- versus low-sugarcereals on the consumption of cereal, refined sugar, fresh fruit,and milk.

Participants and Methods Using an experimental design, we randomly assigned children(n = 91) who were attending summer day camp to receive a breakfastthat included either the choice of 1 of 3 high-sugar cereals(high-sugar condition) or low-sugar cereals (low-sugar condition),as well as low-fat milk, orange juice, bananas, strawberries,and sugar packets. Participants served themselves and completeda background questionnaire after eating. Researchers measuredthe amount and calories consumed of each food.

Results In both conditions, children reported “liking” or “loving” thecereal they chose. Children in the low-sugar cereal conditionconsumed, on average, slightly more than 1 serving of cereal(35 g), whereas children in the high-sugar condition consumedsignificantly more (61 g) and almost twice the amount of refinedsugar in total (24.4 vs 12.5 g). Milk and total calories consumeddid not differ significantly between conditions, but childrenin the low-sugar condition were more likely to put fruit ontheir cereal (54% vs 8%) and consumed a greater portion of totalcalories from fresh fruit (20% vs 13%).

Conclusions Compared with serving low-sugar cereals, high-sugar cerealsincrease children’s total sugar consumption and reduce the overallnutritional quality of their breakfast. Children will consumelow-sugar cereals when offered, and they provide a superiorbreakfast option.

This clinical study is true based on my experience. My kids love these Cherrios low sugar low fat whole grain cereals more than the sugary chocolate laden corn flakes. The good news with these data is that those children in the study who were offered low-sugar cereals enjoyed their breakfast with good satisfaction but only consumed half the amount of refined sugar at breakfast compared with those who ate high-sugar cereals (12.5 g versus 24.4 g, P<0.001). Not only are the parents happy but the kids are satisfied too!

It is really best to start our kids day with a healthy meal that can provide them with calories that matter…

OBJECTIVE: Consumption of sugar-sweetened beverages (SSBs), which include soft drinks, fruit drinks, iced tea, and energy and vitamin water drinks has risen across the globe. Regular consumption of SSBs has been associated with weight gain and risk of overweight and obesity, but the role of SSBs in the development of related chronic metabolic diseases, such as metabolic syndrome and type 2 diabetes, has not been quantitatively reviewed.

RESEARCH DESIGN AND METHODS: We searched the MEDLINE database up to May 2010 for prospective cohort studies of SSB intake and risk of metabolic syndrome and type 2 diabetes. We identified 11 studies (three for metabolic syndrome and eight for type 2 diabetes) for inclusion in a random-effects meta-analysis comparing SSB intake in the highest to lowest quantiles in relation to risk of metabolic syndrome and type 2 diabetes.

RESULTS: Based on data from these studies, including 310,819 participants and 15,043 cases of type 2 diabetes, individuals in the highest quantile of SSB intake (most often 1-2 servings/day) had a 26% greater risk of developing type 2 diabetes than those in the lowest quantile (none or <1 serving/month) (relative risk [RR] 1.26 [95% CI 1.12-1.41]). Among studies evaluating metabolic syndrome, including 19,431 participants and 5,803 cases, the pooled RR was 1.20 [1.02-1.42].

CONCLUSIONS: In addition to weight gain, higher consumption of SSBs is associated with development of metabolic syndrome and type 2 diabetes. These data provide empirical evidence that intake of SSBs should be limited to reduce obesity-related risk of chronic metabolic diseases.

In practical terms, the association between intake of sugary drinks and Diabetes can be translated to something like this:

For every 12 oz sugar laden drink that you order in a restaurant today like the ever famous and popular sugary and tasty Ice Tea or canned OJ… a roughly 25% increase in risk for you to develop Diabetes on top of your risk to gain more weight!

So if one actually drinks 2-3 bottles of Soda per day then the risk is further increased to 30% roughly similar to the risk one gets due to smoking!

Would it be better to take Diet Drinks then? It maybe safer BUT the associated increase in food intake is the culprit. Likewise there are some concerns now that link Diet Sodas also to increased risk of Metabolic syndrome suggesting that artificial sweeteners may have a role in itself.

So my recommendation to my patients is to limit one’s consumption to only 1 diet soda per day and if possible enjoy Water instead!

For the first time, a study has looked at controlling food and specifying the kind of food without restricting it and without any exercise resulted in health benefit. We always recommend the combination of proper healthy diet and exercise to achieve benefit but this new study published in Diabetes Care showed us otherwise.

Objective – To test the effects of two Mediterranean-diet interventions versus a low-fat diet on incidence of diabetes.

Research Design and Methods – Three-arm randomized trial in 418 nondiabetic subjects aged 55-80 years recruited in one center (PREDIMED-Reus, North-Eastern Spain) of the PREDIMED study, a large nutrition-intervention trial for primary cardiovascular prevention in persons at high cardiovascular risk. Participants were randomized to education on a low-fat diet (control group) or one of two Mediterranean diets, supplemented with either free virgin olive oil (1 liter/week) or nuts (30 g/day). Diets were ad libitum and no advice on physical activity was given.

The main outcome was diabetes incidence diagnosed by the 2009 American Diabetes Association criteria. Results – After a median follow-up of 4.0 years, diabetes incidence was 10.1% (95% confidence interval [CI], 5.1-15.1), 11.0% (5.9-16.1), and 17.9% (11.4-24.4) in the Mediterranean-diet with olive oil group, the Mediterranean-diet with nuts group, and the control group, respectively. Multivariable-adjusted hazard ratios of diabetes were 0.49 (0.25-0.97) and 0.48 (0.24-0.96) in the Mediterranean-diet groups supplemented with olive oil and nuts, respectively, compared to the control group. When pooling the two Mediterranean-diet groups compared to the control group, diabetes incidence was reduced by 52% (27-86). In all study arms, increased adherence to the Mediterranean-diet was inversely associated with diabetes incidence. Diabetes risk reduction occurred in the absence of significant changes in body weight or physical activity.

Conclusion –Mediterranean diets without calorie restriction appear to be effective in the prevention of diabetes in subjects at high cardiovascular risk.

The traditional Mediterranean diet, which was recommended in the present study,included the following components:

Use of olive oil for cooking and dressing.

Increased consumption of fruit, vegetables, legumes, and fish.

Reduction in total meat consumption, white meat instead of red meat.

Use of homemade sauce with tomato, garlic, onion, and spices with olive oil to dress vegetables, pasta, rice, and other dishes.

No No to butter, cream, fast-food, sweets, pastries, and sugar-sweetened beverages.

In alcohol drinkers, moderate consumption of red wine.

This diet is not difficult to follow. In fact, the study showed no restriction resulting in no weight loss. Remember, this is to see if this diet can indeed help lower the diabetes risk and not specifically to reduce weight. Calorie intake continues to be a factor in affecting ones weight.

In short, if one aims for both risk reduction and weight loss, then simply restricting calories using this diet plus exercise should achieve optimal benefit!

This diet resulted in a 52% reduction in the risk of developing diabetes. This reduction is understandable considering that the diet is rich in monounsaturated fats as well as anitoxidants known to combat the risk factors of chronic ailments including heart disease…suggesting that long term, this diet should also help reduce risk for heart disease.

But…dont aim for less…aim for more…

Please do continue to aim to be more physically active and achieve OPTIMAL benefit for Your HEALTH!

I have practiced limiting my kids TV times to only during the weekends. This rule includes palying PSP or nintendo. They only open the computer for assignments but never for games. So they resort to board games like scrabble, chess, Game of the generals and Mastermind Game. My eldest also writes his own ” book” about Clyde and Clod and he is now on his third series on these two characters. This aside from finishing 3 ” do it your own” Diary of the Wimpy Kid book. The two girls obviously followed. Kids therefore can have other fun stuff to do and use their brains to think instead of a one sided affair with TV’s. On occasions I allow them to play the Wii provided they sweat. I dont bring them to my daily run this past few days because of the dengue scare especially I run aroung 5:30PM. My wife also bought them Hullahoop where the kids except the youngest can now do the Hullahoop thing up to 400 counts…imagine the sweat!

My rule had basis after all….now comes a study published in Pediatrics linking TV time to Psych problems and peer relationship problems.

Objective: We hypothesized that greater screen use would be associatedwith greater psychological difficulties and that children withhigh levels of screen entertainment use and low levels of physicalactivity would have the most-negative psychological profiles.

Methods: Participants were 1013 children (age, mean ± SD: 10.95± 0.41 years), who self-reported average daily televisionhours and computer use and completed the Strengths and DifficultiesQuestionnaire. Sedentary time (minutes per day with <100cpm) and moderate/vigorous physical activity (MVPA) (minuteswith 2000 cpm) were measured by using accelerometers. Multivariateregression models examined the association between televisionviewing, computer use, sedentary time, and Strengths and DifficultiesQuestionnaire scores, with adjustment for MVPA, age, gender,level of deprivation, and pubertal status.

Results: Greater television and computer use were related to higher psychologicaldifficulty scores after adjustment for MVPA, sedentary time,and confounders. However, sedentary time was inversely relatedto psychological difficulties after adjustment. Children whospent >2 hours per day watching television or using a computerwere at increased risk of high levels of psychological difficulties(television, odds ratio [OR]: 1.61 [95% confidence interval[CI]: 1.20–2.15]; computer, OR: 1.59 [95% CI: 1.32–1.91]),and this risk increased if the children also failed to meetphysical activity guidelines (television, OR: 1.70 [95% CI:1.09–2.61]; computer, OR: 1.81 [95% CI: 1.02–3.20]).

Conclusion:

Both television viewing and computer use are important independenttargets for intervention for optimal well-being for children,irrespective of levels of MVPA or overall sedentary time.

In short, allowing your kids to watch TV for more than two hours a day will result in them a 61% risk of having an increased hyperactivity and emotional problems… PLUS difficulty in concentration and conduct problems which can be an issue with poor grades in school and peer problems with friends and classmates.

Now I see my kids grades getting better without the TV and more attention span. I dont have to pressure them to read or study! Plus the bonding time with them is better and great interaction with board games and fun!

Guys.. Discpline really works. Just adhere to what you think is best for the kids…and once the rule becomes a habit…everything flows smoothly!